Obstructive sleep apnea during anesthesia for wrist fracture in a patient with Micrognathia: important remarks. a case report

Obstructive sleep apnea (OSA) is a major contributor to perioperative morbidity, yet common screening tools like the STOP-BANG questionnaire fail to capture critical anatomical risk factors such as micrognathia. We report a 63-year-old female with micrognathia who underwent wrist fracture repair under a supraclavicular brachial plexus block. Following the procedure, the patient developed severe desaturation ( dropping to 70%). Maintaining a patent airway failed, even with a nasopharyngeal cannula, requiring manual mask ventilation and midazolam reversal with flumazenil. Subsequent sedation with dexmedetomidine also triggered transient desaturation. The surgery was completed without further sedation, and the patient was safely discharged after 2 days for outpatient polysomnography. A question arises: how to safely sedate a patient with sleep apnea syndrome? Micrognathia substantially increases the risk of upper airway collapse under sedation despite a moderate STOP-BANG score (4 points), while supraclavicular blocks add the risk of phrenic nerve paresis. Given the possibility of a difficult intubation, sedation was the preferred approach. So clinicians must be aware of these possibilities.